Manipulator for grasping tissue

ABSTRACT

A manipulator adapted to grasp and draw tissue comprises first and second arms having proximal ends and distal ends separated by a distance. First and second grasping surfaces each connected to and extending from respective distal ends of the first and second arms are biased toward each other by a respective spring force. When the first and second arms are actuated to reduce the distance, the manipulator is configured such that tissue arranged between the first and second grasping surfaces resist actuation of the first and second arms. The first and second arms are further actuatable to overcome the spring force of the first and second grasping surfaces so that the first and second grasping surfaces pivot at respective pivot points such that the distance between the distal ends of the first and second arms is reduced.

CLAIM OF PRIORITY

This application is a continuation of U.S. patent application Ser. No. 13/449,190, filed Apr. 17, 2012 entitled “MANIPULATOR FOR GRASPING TISSUE” which application is incorporated herein by reference in its entirety.

FIELD OF THE INVENTION

This invention relates generally to manipulators used for grasping and holding objects and tissue.

BACKGROUND OF THE INVENTION

Several methods are known for surgically grasping tissue using manipulators. Stability of grasping is commonly increased by roughening and toothing in several patterns to thereby increase the adhesion of contact surfaces of the manipulator. Depth of grasping is commonly increased by taking on a thread, using multiple manipulators applied in several steps, or stitching with a curved needle and tying to seal veins lying in deeper layers.

As technology has developed, there has been an increase in the need for manipulators which are capable of being used in tighter spaces and which are capable of being used in more difficult medical procedures. The application of manipulators in narrow spaces, such as in body cavities or through body orifices, is usually complicated and often requires the use of multiple manipulators applied in several steps, which increases the duration and complexity of a medical procedure, and thus the likelihood of complications.

There is a need to develop a manipulator that reduces the imperfections of known solutions, which is preferably easy and quick to apply, which is suitable for pulling in and grasping tissues with large surface and mass, and which is suitable for manipulation in deeper layers.

SUMMARY

In accordance with an embodiment of the invention, a manipulator adapted to grasp tissue comprises a first arm, a first grasping surface connected to and extending from the first arm, a second arm, and a second grasping surface connected to and extending from the second arm. The first arm and the second arm are separated by a distance. The first grasping surface and the second grasping surface extend toward each other, and are each arranged at an initial position relative to the respective arm from which they extend by a spring force. When the first arm and second arm are actuated to reduce the distance between them, the first grasping surface and the second grasping surface are contactable such that the first grasping surface and the second grasping surface resist actuation of the first arm and the second arm. The first arm and second arm can be further actuated such that a counter force is applied to the first grasping surface and the second grasping surface. When the counter force overcomes the spring force of the first grasping surface and the second grasping surface, the first grasping surface and the second grasping surface pivot at respective pivot points so that the distance between the distal ends of the first and second arms is reduced.

In some embodiments of the invention, the spring force is applied to the first and second grasping surfaces by one of a leaf spring, a torsion spring, a hydraulic device, a pneumatic device, and a magnetic device. In some embodiments of the invention, the first and second grasping surfaces are leaf springs having a parabolic shape and the first and second pivot points are fixed points at which the first and second grasping surfaces are bendable. In some embodiments of the invention, the first and second grasping surfaces are circular in cross-section and are connected to the respective pivot points off-center.

In some embodiments of the invention, the first arm and the second arm are hingedly connected at respective proximal ends, and can optionally be manually actuatable by a user. In other embodiments, the first arm and the second arm are remotely actuatable.

In some embodiments of the invention, the manipulator further comprises a first rigid grasper connected with the first arm and a second rigid grasper connected with the second arm. When the first grasping surface and the second grasping surface reach a maximum actuation, the tissue drawn toward the manipulator is firmly held between the first rigid grasper and the second rigid grasper.

In some embodiments of the invention, the manipulator further comprises a therapeutic or diagnostic device having a first portion connected with the first arm and a second portion connected with the second arm. When the first grasping surface and the second grasping surface reach a threshold, the therapeutic or diagnostic device can be operated. In some embodiments, the therapeutic or diagnostic device is a vein sealer. When the first grasping surface and the second grasping surface reach a threshold actuation, the first vein sealer portion and the second vein sealer portion can be operated to seal a vein held therebetween. In some embodiments of the invention, the first and second vein sealer portions are a bipolar electrode pair. In some embodiments of the invention, the first and second vein sealer portions are a clip applying pair of forceps.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a perspective view of an embodiment of a manipulator in accordance with the present invention including grasping surfaces for drawing tissue toward the manipulator.

FIG. 1B is a detail view of the grasping surfaces of the manipulator of FIG. 1A.

FIGS. 1C-1H are a sequence of detailed views of the grasping surfaces of the manipulator of FIGS. 1A and 1B being actuated and released.

FIG. 1I is an exploded view of the manipulator of FIGS. 1A-1H.

FIG. 2A is a perspective view of an alternative embodiment of a manipulator in accordance with the present invention comprising disposable heads each including a distal portion of an arm and a grasping surface.

FIG. 2B is a detail view of the grasping surfaces of the manipulator of FIG. 2A.

FIGS. 3 and 4 are partial perspective views of attachment mechanisms for attaching grasping surfaces to manipulator arms.

FIG. 5A is a perspective view of an alternative embodiment of a manipulator in accordance with the present invention.

FIG. 5B is a detail view of grasping surfaces of the manipulator of FIG. 5A.

FIG. 6 is a detail view of grasping surfaces of an alternative manipulator.

FIG. 7A is a partial exploded view and FIG. 7B is a top detail view of grasping surfaces of an alternative manipulator.

FIGS. 8A and 8B are partial top views of an alternative embodiment of a manipulator in accordance with the present invention in an open and closed configuration, respectively.

FIGS. 8C and 8D are side views of the manipulator of FIGS. 8A and 8B in an open and closed configuration, respectively.

FIG. 9A is a perspective view of an alternative embodiment of a manipulator in accordance with the present invention.

FIG. 9B is a detail view of the grasping surfaces of the manipulator of FIG. 9A.

FIG. 10A is a partial exploded view of an alternative embodiment of a manipulator in accordance with the present invention.

FIG. 10B is a top view of the grasping surfaces of the manipulator of FIG. 10A.

FIGS. 11A and 11B are partial end views of a further embodiment of a manipulator in accordance with the present invention in an open and closed configuration, respectively.

FIGS. 11C and 11D are side views of the manipulator of FIGS. 11A and 11B in an open and closed configuration, respectively.

FIG. 12 is a top view of a manipulator comprising the arms and grasping surfaces of FIGS. 11A-11D in an open configuration.

FIG. 13 is a side view of an endoscope for use with embodiments of manipulators in accordance with the present invention.

FIGS. 14A and 14B are partial top view of a still further embodiment of a manipulator in accordance with the present invention engaging tissue and isolating a vein.

FIG. 15 is a schematic view of the grasping surface for use with embodiments of manipulators in accordance with the present invention.

FIGS. 16, 17, and 18 are detailed views of varying grasping surfaces usable with embodiments of manipulators in accordance with the present invention.

FIGS. 19A and 19B are partial top views of an alternative embodiment of a manipulator in accordance with the present invention in an open and closed configuration, respectively.

FIG. 19C is a partial side view of the manipulator of FIGS. 19A and 19B.

FIGS. 20A and 20B are partial top views of an alternative embodiment of a manipulator in accordance with the present invention in a closed and open configuration, respectively.

FIGS. 21A-21E illustrate advancement of a grasping surface for use with embodiments of manipulators in accordance with the present invention as the manipulator arms are closed.

FIGS. 22A and 22B are partial top views of an embodiment of a manipulator in accordance with the present invention for advancing a thread along an axis.

FIGS. 23A and 23B are partial end views of an embodiment of a manipulator in accordance with the present invention for advancing a thread along an axis.

FIG. 23C is a partial side view of the manipulator of FIGS. 23A and 23B.

FIG. 23D is a partial top view of the manipulator of FIGS. 23A-23C.

FIGS. 24A-24D illustrate incremental advancement of a target using embodiments of grasping surfaces for use with manipulators in accordance with the present invention.

FIGS. 25A-25E illustrate an alternative embodiment of a grasping surface for use with embodiments of manipulators in accordance with the present invention and incremental advancement of the grasping surface adjust the size of a tube.

FIGS. 26A-26D illustrate a further embodiment of a grasping surface for use with embodiments of manipulators in accordance with the present invention and incremental advancement of the grasping surface within a tube.

FIGS. 27A and 27B are partial top views of an embodiment of a manipulator in accordance with the present invention in an open and closed configuration, respectively.

FIGS. 28A-28E illustrate an alternative embodiment of a grasping surface for use as a locomotive device in accordance with the present invention.

FIGS. 29A-29C illustrate an embodiment of an advanceable endoscope in accordance with the present invention.

FIGS. 30A and 30B illustrate an alternative embodiment of a grasping surface in accordance with the present invention in an open and closed configuration.

DETAILED DESCRIPTION

The following description is of the best modes presently contemplated for practicing various embodiments of the present invention. The description is not to be taken in a limiting sense but is made merely for the purpose of describing the general principles of the invention. The scope of the invention should be ascertained with reference to the claims. In the description of the invention that follows, like numerals or reference designators will be used to refer to like parts or elements throughout. In addition, the first digit of a reference number identifies the drawing in which the reference number first appears.

FIGS. 1A-1I illustrate an embodiment of a manipulator 100 in accordance with the present invention adapted for grasping and pulling tissues. The manipulator 100 comprises a pair of arms 102 a, 102 b each of which is connected with a grasping surface 104 a, 104 b at a pivot point 106 a, 106 b. The grasping surfaces 104 a, 104 b are leaf springs that resemble fingers having a semi-parabolic shape that curve outward with a convex orientation relative to respective arms 102 a, 102 b. The pivot points 106 a, 106 b are fixed points at which the grasping surfaces 104 a, 104 b are fixed and about which the grasping surfaces 104 a, 104 b bend. As shown, the arms 102 a, 102 b of the manipulator 100 resemble a pair of forceps. Levers 152 a, 152 b connected at a hinge 156 actuate the arms 102 a, 102 b when urged together. Proximal ends of the levers 152 a, 152 b includes finger loops 150 a, 150 b, and a locking mechanism 154 a, 154 b to allow the manipulator 100 to act as a clamp to fix tissue in place. The manipulator can be useful, for example, in combination with endoscopes, enabling a large quantity of tissue on a large surface to be precisely grasped. All of the embodiments of manipulators described herein can be hand actuated, for example as a pair of forceps, or alternatively arms of a manipulator can extend from a non-hand actuated tool such as a robotic device controlled by a physician or controlled by an automated system.

In FIGS. 1A and 1B, the manipulator 100 is open, in that the grasping surfaces 104 a, 104 b are arranged to contact tissue for grasping. Once the grasping surfaces 104 a, 104 b are contacted to the target tissue, the manipulator 100 can be actuated to draw tissue into the manipulator 100 (i.e., toward the user holding the manipulator). The spring force of the grasping surfaces 104 a, 104 b and optional roughing and/or toothing of the grasping surfaces 104 a, 104 b resist slippage of the tissue held therebetween. Referring to FIGS. 1C-1H, the arrangement of the grasping surfaces 104 a, 104 b relative to each other is shown at stages I-IV of actuation of the manipulator 100 and at stages V-VI of release of the manipulator 100. As can be seen, the grasping surfaces 104 a, 104 b are offset from the arms 102 a, 102 b of the manipulator by the pivot points 106 a, 106 b which extend laterally away from the arms 102 a, 102 b. That is, the grasping surfaces 104 a, 104 b are offset from a plane defined by the arms 102 a, 102 b. This offset allows the grasping surfaces 104 a, 104 b to avoid physical interference with the arms 102 a, 102 b as the arms 102 a, 102 b are actuated toward each other. This can be seen most clearly in FIG. 1F, where the distal ends of the grasping surfaces 104 a, 104 b overlap the arms 102 a, 102 b. As can be seen, the grasping surfaces 104 a, 104 b contact each other, and the grasping surfaces 104 a, 104 b urge each other away from the distal ends of the arms 102 a, 102 b (i.e., the pivot points 106 a, 106 b) toward the proximal ends of the arms 102 a, 102 b. Where tissue is arranged between the contact points, the tissue is drawn into the manipulator 100. This can be seen, for example, in FIGS. 14A and 14B described below. As shown in FIG. 1F, as actuation proceeds, the grasping surfaces 104 a, 104 b bend at the pivot points 106 a, 106 b until relatively flat portions of the grasping surfaces 104 a, 104 b contact each other. Where tissue is arranged between the grasping surfaces 104 a, 104 b, the relatively flat portions provide increased surface area, including any roughened and/or toothed surface area, for securing the tissue and preventing slippage when the locking mechanism 154 a, 154 b of the manipulator 100 is engaged to fix the tissue in place. As can be seen in FIGS. 1G and 1H, as the manipulator 100 is released, the spring force of the grasping surfaces 104 a, 104 b urge the grasping surfaces 104 a, 104 b (and consequently the arms 102 a, 102 b) apart to their original position.

FIG. 1I is an exploded view of the manipulator 100 of FIGS. 1A-1H. In some embodiments, manipulators in accordance with the present invention can be made from a sterilizable, durable material, such as surgical grade stainless steel or polyether ether ketone (PEEK). In other embodiments, for example where a disposable instrument is desired for use, manipulators in accordance with the present invention can be made of a thermopolymer or combination of polymers. In other embodiments, manipulators in accordance with the present invention can be made of a combination of materials. For example, manipulators in accordance with the present invention can comprise levers and arms made from a metal, such as surgical grade stainless steel connected with a head including the grasping surfaces made of a polymer. One of ordinary skill in the art, upon reflecting on the teachings herein and the materials used in surgical and medical procedures, will appreciate the myriad different materials with which manipulators in accordance with the present invention can be formed.

FIGS. 2A and 2B illustrate an alternative embodiment of a manipulator 200 in accordance with the present invention adapted for grasping and pulling tissues. The manipulator 200 comprises a pair of arms 202 a, 202 b each of which is connected with a removable head 201 a, 201 b. The removable head 201 a, 201 b includes a grasping surface 204 a, 204 b connected with the head 201 a, 201 b at a pivot point 206 a, 206 b. The grasping surfaces 204 a, 204 b are rigid or semi-rigid surfaces extending about one-half to three-quarters of the circumference of a ring and connected with a pivot point 206 a, 206 b near one end, although in other embodiments the grasping surfaces can have a different shape. A leaf spring 203 a, 203 b is nested within the inner surface of each of the grasping surfaces 204 a, 204 b applying a bias spring force to resist the grasping surfaces 204 a, 204 b pivoting toward each other. The pivot points 206 a, 206 b include shafts that allow the grasping surfaces 204 a, 204 b to pivot relative to the head 201 a, 201 b (as opposed to merely allowing bending as in the previous embodiment). As above, the manipulator 200 further comprises levers 252 a, 252 b connected at a hinge 256 actuate the arms 202 a, 202 b when urged together. Proximal ends of the levers 252 a, 252 b includes finger loops 250 a, 250 b, and a locking mechanism 254 a, 254 b to allow the manipulator 200 to act as a clamp to fix tissue in place.

Once the grasping surfaces 204 a, 204 b are contacted to the target tissue, the manipulator 200 can be actuated to draw tissue into the manipulator 200 (i.e., toward the user holding the manipulator). As can be seen in FIG. 2B, the grasping surfaces 204 a, 204 b are offset from the arms 202 a, 202 b of the manipulator 200. That is, the grasping surfaces 204 a, 204 b are offset from a plane defined by the arms 202 a, 202 b to allow the grasping surfaces 204 a, 204 b to avoid physical interference with the arms 202 a, 202 b as the arms 202 a, 202 b are actuated toward each other. As the arms 202 a, 202 b are actuated, the grasping surfaces 204 a, 204 b approach each other and captured tissue arranged therebetween urge the grasping surfaces 204 a, 204 b to rotate inwardly so that the hinge points 206 a, 206 b can come together. The tissue arranged between the grasping surfaces 204 a, 204 b is drawn into the manipulator 200. When the manipulator 200 is released, the spring force of the leaf springs 203 a, 203 b urge the grasping surfaces 204 a, 204 b to rotate in opposite directions, pushing the arms 202 a, 202 b apart to their original position.

As mentioned, the embodiment of FIGS. 2A and 2B include detachable heads 201 a, 201 b. Use of a detachable heads can allow the manipulator 200 to be fit with appropriately sized heads based on the procedure performed, with heads including additional therapeutic and/or diagnostic tools such as vein sealers. Use of detachable heads can also allow recently used heads to be replaced with recently sterilized heads. The detachable heads can be made from metal, such as surgical grade stainless steel, or the detachable heads can be formed of a thermopolymer for reduced cost and disposability, for example. The manipulator can also be semi-disposable, with a levers and arms being made from surgical grade stainless steel and detachable heads being made of a thermopolymer, for example. FIGS. 3 and 4 illustrate two different mechanisms for connecting a detachable head with the arms of a manipulator. FIG. 3 includes a spring biased sphere 305 b extending from an attachment point of an arm 302 b that pops into a complementary feature (not shown) in the inner surface of the head 304 b. FIG. 4 includes a pair of tines 405 b extending from the head 404 b that are inserted into a hollow cavity of the arm 402 b until the head 404 b and tines 405 b latch into complementary features of the arm 402 b.

FIGS. 5A and 5B illustrate an alternative embodiment of a manipulator 500 in accordance with the present invention adapted for grasping and pulling tissues. The manipulator 500 comprises a pair of arms 502 a, 502 b each of which is connected with a grasping surface 504 a, 504 b at a pivot point 506 a, 506 b. The grasping surfaces 504 a, 504 b are rigid or semi-rigid surfaces which are cylindrically shaped and connected to the pivot points 506 a, 506 b off-center, near an edge of the grasping surfaces 504 a, 504 b. In other embodiments, the grasping surfaces need not be circular in cross-section. For example, the grasping surfaces can be elliptical in cross-section. Helical torsion springs 503 a, 503 b are arranged between respective arms 502 a, 502 b and grasping surfaces 504 a, 504 b to apply a bias spring force to resist the grasping surfaces 504 a, 504 b pivoting toward each other. The pivot points 506 a, 506 b include shafts that allow the grasping surfaces 504 a, 504 b to pivot relative to the arms 502 a, 502 b. As above, the manipulator 500 further comprises levers 552 a, 552 b connected at a hinge 556 actuate the arms 502 a, 502 b when urged together. Proximal ends of the levers 552 a, 552 b includes finger loops 550 a, 550 b, and a locking mechanism 554 a, 554 b to allow the manipulator 500 to act as a clamp to fix tissue in place.

Once the grasping surfaces 504 a, 504 b are contacted to the target tissue, the manipulator 500 can be actuated to draw tissue into the manipulator 500 (i.e., toward the user holding the manipulator). As can be seen in FIG. 5B, the grasping surfaces 504 a, 504 b are offset from the arms 502 a, 502 b of the manipulator 500. That is, the grasping surfaces 504 a, 504 b are offset from a plane defined by the arms 502 a, 502 b to allow the grasping surfaces 504 a, 504 b to avoid physical interference with the arms 502 a, 502 b as the arms 502 a, 502 b are actuated toward each other. As the arms 502 a, 502 b are actuated, the grasping surfaces 504 a, 504 b approach each other and captured tissue arranged therebetween urge the grasping surfaces 204 a, 204 b to rotate inwardly so that the hinge points 506 a, 506 b can come together. The tissue arranged between the grasping surfaces 504 a, 504 b is drawn into the manipulator 500. The grasping surfaces 504 a, 504 b are textured along their edges to resist slippage of tissue held therebetween. The texture shown includes a series of diagonal grooves. However, myriad different texture patterns and features such as roughening, toothing, and grooving can be used with any of the embodiments of manipulators described herein, some patterns of which are described below. When the manipulator 500 is released, the spring force of the helical torsion springs 503 a, 503 b urge the grasping surfaces 504 a, 504 b to rotate in opposite directions, pushing the arms 502 a, 502 b apart to their original position.

FIG. 6 illustrates an alternative embodiment of a manipulator 600 in accordance with the present invention adapted for grasping and pulling tissues. The manipulator 600 resembles the manipulator 500 of FIGS. 5A and 5B. However, grasping surfaces 604 a, 604 b of the manipulator 600 connected with arms 602 a, 602 b each include pegs 640 a, 640 b and are spring biased by leaf springs 603 a, 603 b connected between respective pegs 604 a, 604 b and arms 602 a, 602 b. The grasping surfaces 604 a, 604 b are textured along their edges to resist slippage of tissue held therebetween. However, the texture differs from previous embodiments, and is shown to illustrate one of multiple different textures usable with the grasping surfaces 604 a, 604 b.

FIGS. 7A and 7B illustrate an alternative embodiment of a manipulator 700 in accordance with the present invention adapted for grasping and pulling tissues. The manipulator 700 resembles the manipulators 500, 600 of FIGS. 5 and 6. However, grasping surfaces 704 a, 704 b of the manipulator 700 are spring biased with a leaf spring 703 arranged in a cavity around the pivot point 706 at the end of respective arms 702 a, 702 b. The cavity has a stop 748 a, 748 b that contacts a key 740 a, 740 b which is biased by a spring 703 a, 703 b held within the cavity. Rotation of the grasping surfaces 704 a, 704 b is restricted in one direction by the stops 748 a, 748 b, and is resisted in the opposite direction by the springs 703 a, 703 b. As shown, the pivot points 706 are connected and are free rotate relative to respective arms 702 a, 702 b by a pin 746. The pivot points 706 are received within respective cavities of the grasping surfaces 704 a, 704 b. The cavities are sealed by caps 742 a, 742 b which are fixed in position by screws 744 a, 744 b or other fixation device. Note that the peg 746 and pivot point 706 are shown for only the right head, but the features are intended to be identical for the left head in this embodiment. Sealing the spring bias mechanism can, for example, reduce the amount of exposed moving parts of the manipulator thereby potentially increasing safety and prevent additional points of contamination accumulation during procedures

FIGS. 8A and 8B illustrate an alternative embodiment of a manipulator 800 in accordance with the present invention. The manipulator 800 comprises a pair of arms 802 a, 802 b each of which is connected with a grasping surface 804 a, 804 b at a pivot point 806 a, 806 b. Each of the grasping surfaces 804 a, 804 b has a semi-circular shape that curves inward relative to the other grasping surface 804 a, 804 b. The grasping surfaces 804 a, 804 b are spring biased, and can be spring biased using any of the spring features described in embodiments described herein, or any other spring features that may be contemplated by one of ordinary skill in the art upon reflecting on the teachings presented herein. The manipulator 800 further comprises rigid grasping sections 808 a, 808 b each extending from a portion of a corresponding arm 802 a, 802 b. The manipulator can be useful, for example, in combination with endoscopes, enabling a strong, but rougher grasping of a large quantity of tissue.

In FIG. 8A, the manipulator 800 is open, in that the grasping surfaces 804 a, 804 b are arranged to contact tissue for grasping. Once the grasping surfaces 804 a, 804 b are contacted to the target tissue, they are actuated by moving the arms 802 a, 802 b toward each other and urging the manipulator 800 toward the target tissue. As the arms 802 a, 802 b are moved closer together, the grasping surfaces 804 a, 804 b rotate at their pivot points 806 a, 806 b, grasping tissue and pulling tissue into the gap between the arms 802 a, 802 b. As the arms come together, the tissue is further contacted and captured by the rigid grasping sections 808 a, 808 b, which offer increased surface area for contacting the tissue, and which rigidly hold captured tissue in place. FIGS. 8C and 8D are side views of the manipulator 800 in an open and closed configuration, respectively. An offset can be seen between the grasping surfaces 804 a, 804 b and the grasping sections 808 a, 808 b that avoids physical interference between the grasping surfaces 804 a, 804 b and the grasping sections 808 a, 808 b when the manipulator 800 is actuated. Referring again to FIG. 8A, the arms 802 a, 802 b of the manipulator 800 are mechanically bendable about two pivot points. The arms 802 a, 802 b can be bent perpendicular to an axis of the arms 802 a, 802 b at a first pivot point 810 a, 810 b, i.e. into or out of the page from top to bottom. The arms 802 a, 802 b can also be bent about the axis of the arms 802 a, 802 b at a second pivot point 812 a, 812 b, i.e. into or out of the page from left to right. By mechanically bending the arms 802 a, 802 b, the grasping surfaces 804 a, 804 b can be arranged at a desired angle, including acute and obtuse angles.

FIGS. 9A and 9B illustrate an alternative embodiment of a manipulator 900 in accordance with the present invention adapted for grasping and pulling tissues. The manipulator 900 comprises a pair of arms 902 a, 902 b each of which is connected with a grasping surface 904 a, 904 b at a pivot point 906 a, 906 b. The distal portions of the arms 902 a, 902 b are angled at 90° from the proximal ends of the arms 902 a, 902 b and the levers 952 a, 952 b so that a user can access target tissue located at an angle relative to an incision, for example. In other embodiments, the distal portions of the arms can extend at a different angle relative to the proximal ends of the arms and/or the levers. The grasping surfaces 904 a, 904 b are rigid or semi-rigid surfaces which have a frustum shape. The frustum shape is intended to allow the edges of the grasping surfaces to mate along their surface, and accounts for the relative angle introduced by the geometry of the hinged arms 902 a, 902 b. For manipulators that are not actuated at a hinge, but rather include arms arranged parallel to each other during actuation the grasping surface can be cylindrical.

The grasping surfaces 904 a, 904 b each include pegs 940 a, 940 b and are spring biased by leaf springs 903 a, 903 b connected between respective pegs 904 a, 904 b and arms 902 a, 902 b. The springs 903 a, 903 b resist the grasping surfaces 904 a, 904 b, and by extension the pivot points 906 a, 906 b from being urged together. The pivot points 906 a, 906 b include shafts that allow the grasping surfaces 904 a, 904 b to pivot relative to the arms 902 a, 902 b. As above, the manipulator 900 further comprises levers 952 a, 952 b connected at a hinge 956 actuate the arms 902 a, 902 b when urged together. Proximal ends of the levers 952 a, 952 b includes finger loops 950 a, 950 b, and a locking mechanism 954 a, 954 b to allow the manipulator 900 to act as a clamp to fix tissue in place. Once the grasping surfaces 904 a, 904 b are contacted to the target tissue, the manipulator 900 can be actuated to draw tissue away from the target location. As with previous embodiments, when the manipulator 900 is released, the spring force of the springs 903 a, 903 b urge the grasping surfaces 904 a, 904 b to rotate in opposite directions, pushing the arms 902 a, 902 b apart to their original position.

FIGS. 10A and 10B illustrate an alternative embodiment of a manipulator 1000 in accordance with the present invention adapted for grasping and pulling tissues. The manipulator 1000 resembles the manipulator 900 of FIGS. 9A and 9B. However, leaf springs 1003 a, 1003 b connected between two pings 1040 a, 1040 b and a bracket-and-screw 1042 a, 1042 b arrangement of the arms 1002 a, 1002 b. Upon reflecting on the teaching herein and the differences between the two embodiments, one of ordinary skill in the art will appreciate other mechanisms for exerting a spring force on the grasping surfaces 1004 a, 1004 b, all of which are contemplated and intended to be within the scope of the present invention. Further, as shown in FIG. 10B, the grasping surfaces 1004 a, 1004 b are rounded in shape along the edges to account for an angle introduced by the compound arms 1002 a, 1002 b. It can be useful when the distal portions of the arms 1002 a, 1002 b are angled at variable degrees relative to the proximal ends of the arms 1002 a, 1002 b and the levers, the rounded shape can allow the edges of the grasping surfaces 1004 a, 1004 b to mate along their surface. In some embodiments, the grasping ticket can be made from a more flexible material to allow the edges to at least partially flatten out against grasped tissue to increase surface contact.

FIGS. 11A-11D illustrate an alternative embodiment of a manipulator 1100 in accordance with the present invention. The manipulator 1100 comprises a pair of arms 1102 a, 1102 b each of which is connected with a grasping surface 1104 a, 1104 b at a pivot point 1106 a, 1106 b. Each of the grasping surfaces 1104 a, 1104 b has a semi-circular shape that curves inward relative to the other grasping surface 1104 a, 1104 b. The grasping surfaces 1104 a, 1104 b are spring biased, and can be spring biased using any of the spring features described in embodiments described herein, or any other spring features that may be contemplated by one of ordinary skill in the art upon reflecting on the teachings presented herein. The manipulator 1100 also includes a vein sealer 1108 a, 1108 b associated with the arms 1102 a, 1102 b.

In FIG. 11A, the manipulator 1100 is open, in that the grasping surfaces 1104 a, 1104 b are arranged to contact tissue for grasping. Once the grasping surfaces 1104 a, 1104 b are contacted to the target tissue, they are actuated by moving the arms 1102 a, 1102 b toward each other and urging the manipulator 1100 toward the target tissue. As the arms 1102 a, 1102 b are moved closer together, the grasping surfaces 1104 a, 1104 b rotate at their pivot points 1106 a, 1106 b, grasping tissue and pulling tissue into the gap between the arms 1102 a, 1102 b. As the arms 1102 a, 1102 b come together, the vein sealer 1108 a, 1108 b can be activated to seal a vein. The vein sealer 1108 a, 1108 b can be, for example, a bipolar electrode pair, which destroys the tissue part in between, but can alternatively also be a clip applying pair of forceps, or some other mechanism. A manipulator 1100 having a vein sealer 1108 a, 1108 b as contemplated herein can be useful, for example, in endoscopic situations, where sealing veins lying in the deeper layers of cavity walls is necessary. Tissue can be grasped in one move and pulled into the manipulator, and the vein can be sealed without damaging the other deeper layers of the cavity walls. In addition, as with all other embodiments disclosed herein, the manipulator can include other therapeutic and/or diagnostic tools besides a vein sealer.

FIGS. 11C and 11D are side views of the manipulator 1100 in an open and closed configuration, respectively. An offset can be seen between the grasping surfaces 1104 a, 1104 b and the vein sealer 1108 a, 1108 b that avoids physical interference between the grasping surfaces 1104 a, 1104 b and the vein sealer 1108 a, 1108 b when the manipulator 1100 is actuated. As shown, the arm 1102 a, 1102 b of the manipulator 1100 has a perpendicular bend so that the manipulator 1100 can approach the target tissue in a direction substantially parallel to the surface of the target tissue. The arm of the manipulator can alternatively form an obtuse or acute angle. In this way, sequences requiring several complex manipulations can be replaced with a single move.

FIG. 12 is a top view of a manipulator 1200 comprising the arms and grasping surfaces of FIGS. 11A-11D in an open configuration. The manipulator 1200 comprises a pair of arms 1102 a, 1102 b have a perpendicular bend and are connected together at a pivot 1256 and having levers 1252 a, 1252 b for actuation of the arms 1102 a, 1102 b. Proximal ends of the levers 1252 a, 1252 b includes finger loops 1250 a, 1250 b. Each of the arms 1102 a, 1102 b is connected with a grasping surface 1104 a, 1104 b at a pivot point 1106 a, 1106 b. The grasping surfaces 1104 a, 1104 b are actuated to pivot perpendicular to the arms (i.e., in the plane of the page). A user actuates the manipulator 1200 using the handles 1252 a, 1252 b. As the arms 1102 a, 1102 b approach each other the grasping surfaces 1104 a, 1104 b rotate about a shaft at the pivot point 1106 a, 1106 b. Each shaft is aligned along the corresponding arm 1102 a, 1102 b so that the grasping surfaces 1104 a, 1104 b rotate perpendicular to the arms 1102 a, 1102 b.

FIG. 13 illustrates a further embodiment of a manipulator 1300 in accordance with the present invention comprising a single primary arm 1330. The arm 1330 includes two location joints 1332, 1334 that allow a head 1301 of the manipulator 1300 to rotate in one or two axes and a bending joint 1336 that allows the head 1301 to bend so that the head is aligned at an angle relative to an axis defined by the arm 1302. The head 1301 comprises a pair of smaller arms 1302 a, 1302 b pivotally connected with each other at a main pivot point 1303. Each of the arms 1302 a, 1302 b is connected with a grasping surface 1304 a, 1304 b at a pivot point 1306 a, 1306 b. The manipulator 1300 also includes a vein sealer 1308 a, 1308 b portions of which extend from each arm 1302 a, 1302 b. Although in other embodiments, the manipulator can include some other therapeutic and/or diagnostic tool.

The arms 1302 a, 1302 b can be urged together at the pivot point 1303 connecting them. The grasping surfaces 1304 a, 1304 b are actuated as the arms 1302 a, 1302 b are urged together. The grasping surfaces 1304 a, 1304 b grasp tissue and pull tissue into the gap between the arms 1302 a, 1302 b. As the arms 1302 a, 1302 b come together, the vein sealer 1308 a, 1308 b penetrates the tissue to seal a vein.

FIGS. 14A and 14B illustrate a further embodiment of a manipulator 1400 in accordance with the present invention similar to the embodiment of FIGS. 11A and 11B, but having a vein sealer 1408 a, 1408 b applied to target tissue to seal a vein. The manipulator 1400 comprises a pair of arms 1402 a, 1402 b each of which is connected with a grasping surface 1404 a, 1404 b at a pivot point 1406 a, 1406 b. Each of the grasping surfaces 1404 a, 1404 b has a semi-circular shape that curves inward relative to the other grasping surface 1404 a, 1404 b. The manipulator 1400 also includes the vein sealer 1408 a, 1408 b, but unlike in previous embodiments, the portions are connected to each arm 1402 a, 1402 b by additional, flexible or semi-flexible arms 1440 a, 1440 b that can enable the vein sealer 1408 a, 1408 b to function in a semi-closed state of the manipulator 1400, for example. As with other embodiments, the manipulator can include some other therapeutic and/or diagnostic tool.

In FIG. 14A, the manipulator 1400 is open, and the grasping surfaces 1404 a, 1404 b are pressed against the tissue 6 at the target site with the vein 2 arranged between the grasping surfaces 1404 a, 1404 b. As the arms 1402 a, 1402 b are urged together, the grasping surfaces 1404 a, 1404 b engage the tissue until the resistance of the tissue between the grasping surfaces 1404 a, 1404 b overcomes a spring bias so that the grasping surfaces 1404 a, 1404 b begin to pivot inward. As the grasping surfaces 1404 a, 1404 b pivot inward, tissue is drawn between the arms 1402 a, 1402 b of the manipulator 1400. As the arms 1402 a, 1402 b are further urged together and urged closer to muscle 4, the grasping surfaces 1404 a, 1404 b continue to grasp and pull tissue into the gap between the arms 1402 a, 1402 b. As can be seen in FIG. 14B, a contact surface of the tissue 14 is drawn inward as the head of the manipulator 1400 is urged toward the muscle 4 and the vein 2 is arranged between the vein sealer 1408 a, 1408 b portions. The vein sealer 1408 a, 1408 b can then seals the vein 2. (For example, where the vein sealer includes a pair of electrodes, the electrodes can be fired.)

FIG. 15 is an isolated schematic view of a grasping surface 1500 for use with embodiments of manipulators in accordance with the present invention. The grasping surface 1500 extends in a semi-elliptical shape away from a pivot point 1506. The distal portion 1520 of the grasping surface 1500 has a texture that is designed for grasping, while the main section 1522 trailing the distal portion 1520 to a proximal end has a texture that is designed for pulling tissue in.

FIGS. 16-18 illustrate additional, detail views of different grasping surfaces 1604, 1704, 1804 for use with embodiments of manipulators in accordance with the present invention. Referring to FIG. 16, the rolling section 1604 has varying width with the distal and proximal ends of the rolling section 1604 substantially connected by a back edge 1622 that is not textured and has a slightly compound angle. The grasping edge 1620 of the rolling section 1604 is toothed, with the teeth biased in the direction towards pulling-in. The bias of the teeth toward pulling-in encourages the grasping surface to grab target tissue when actuating the manipulator to a closed position, while substantially avoiding grabbing tissue when the manipulator is released or actuated to an open position. The rotation shaft 1606 is farther in than the edge of the grasping surface 1604. Referring to FIG. 17, the grasping surface 1704 resembles previously described grasping surfaces in that its width is generally consistent along the grasping surface 1704. A grasping edge 1720 of the rolling section 1704 is toothed, with the teeth biased in the direction towards of pulling-in. The rotation shaft 1706 is farther in than the edge of the grasping surface 1700. Referring to FIG. 18, the rolling section 1804 has varying width and the grasping edge 1820 is shaped in a spiral. The grasping edge 1820 of the rolling section 1804 is toothed, with the teeth biased in the direction towards of pulling-in. The rotation shaft 1806 is even farther in than the edge of the grasping surface 1804 than the previous grasping surfaces.

FIGS. 19A-19C illustrate a further grasping surface for use with embodiments of manipulators in accordance with the present invention. FIGS. 19A and 19B are partial top views of a grasping surface 1904 connected with an arm 1902. The grasping surface 1904 is semi-circular in shape. The grasping surface 1904 is not connected to the arm 1902 by a shaft. Rather, the grasping surface 1904 bends at a pivot point 1906, similar to the embodiment of FIGS. 1A-1I. The distal end of the grasping surface 1904 is connected to the proximal end of the grasping surface 1904 by a brake and plate spring 1924. When the grasping surface 1904 is actuated, the brake and plate spring 1924 resists collapse of the grasping surface 1904, and helps return the grasping surface 1904 to the unactuated position. The manipulator of FIGS. 19A-19C further comprises a rigid grasper 1908. As can be seen in the side view of FIG. 19C, the rigid grasper 1908 is offset from the grasping surface 1904.

FIGS. 20A and 20B are partial top views illustrating a further grasping surface 2004 for use with embodiments of manipulators in accordance with the present invention. The grasping surface 2004 is connected with an arm 2002, and as above bends at a corner 2006, rather than rotating. The grasping surface 2004 is semi-parabolic in shape; however there is no brake and plate spring, and the grasping surface 2004 is bendable so that the grasping surface 2004 is urged substantially against the arm 2002. The grasping surface 2004 pressed to the arm 2002 can even be deformed, by means of which the diameter of the manipulator can be decreased during leading, substantially reducing or avoiding the offset of some embodiments, such as the embodiment shown in FIG. 1.

The geometric shape of the grasping surfaces of FIGS. 19A-20B can be of several types, taking into consideration that the pivot points are farther and farther from the rotation angle made up by the joint have to be located farther from the rotation angle in the moment of grasping.

FIGS. 21A-21E illustrate actuation of a pair of the grasping surfaces 2104 a, 2104 b of FIG. 21. As the pivot points 2106 a, 2106 b of the grasping surfaces 2104 a, 2104 b are urged together and the grasping edges 2120 a, 2120 b of the grasping surfaces 2104 a, 2104 b engage tissue, the grasping surfaces 2104 a, 2104 b are pivoted at the pivot points 2106 a, 2106 b so that the tissue can be into the manipulator by teeth of the grasping edges 2120 a, 2120 b. The teeth draw in the tissue and advance the tissue into the manipulator 2100 so that the target can be acted on. For example, the target may be a vein, and the manipulator may be actuated to seal the vein.

While the previous embodiments have described manipulators having grasping surfaces that are usable to grasp and pull tissue toward the manipulator, in still other embodiments manipulators having grasping surfaces that urge thread and other materials outward and away from the manipulator and outward toward a target.

FIGS. 22A and 22B are partial top views illustrating grasping surfaces 2204 for use with embodiments of manipulators in accordance with the present invention to urge thread 10, wire, or any target object outward and away from the manipulator. When the rotations shafts 2206 a, 2206 b of the grasping surfaces are urged together, the grasping surface 2204 a, 2204 b are pivoted downward toward the bottom of the page. The grasping edge 2220 a, 2220 b has teeth or any other structure or texture pattern that can grasp the thread 10 and urge it downward of the page so that the thread 10 is advanced away from the manipulator.

FIGS. 23A and 23B are partial end views of an embodiment of a manipulator 2300 in accordance with the present invention for advancing a thread along an axis. The grasping surfaces 2304 a, 2304 b are circular in shape and grooved. The grasping surfaces 2304 a, 2304 b are connected with arms 2302 a, 2302 b of the manipulator 2300 and have pivot points 2306 a, 2306 b that are off-center so that the grasping surfaces 2304 a, 2304 b are cammed in their motion. As shown in FIG. 23B, a line guide 2340 feeds a thread or line between the grasping surfaces 2304 a, 2304 b to prevent binding.

FIG. 23C is a side view of the manipulator 2300 of FIGS. 23A and 23B showing the line guide 2340 and a grasping surface 2304 a relative to an arm 2302 a of the manipulator 2300. Referring to FIG. 23D, when the arms 2302 a, 2302 b are urged together the grasping surfaces 2306 a, 2306 b are rotated, drawing a line or thread 10 through the line guide 2340 and outward of the manipulator 2300.

FIGS. 24A-24D illustrate incremental advancement of grasping surfaces 2404 a, 2404 b for use with embodiments of manipulators in accordance with the present invention to advance a target, such as a thread, as the manipulator arms are closed. The pivot points 2406 a, 2406 b in the circular grasping surfaces can move one way in a circular groove. When the pivot point is stopped it is signed with ‘x’, when it's moving it is signed with a small arrow. Opening and closing the manipulator are signed with large horizontal arrows above the grasping surfaces. Movement of the target arranged between the grasping surfaces is signed with a large vertical arrow. When target movement is stopped, it is signed with an ‘X’ below the grasping surfaces. The embodiment of FIGS. 24A-24D is similar to that of FIGS. 23A-23D, until the manipulator is in a closed configuration. The manipulator can then be opened with the grasping surfaces remaining sufficiently closed and motionless such that the target is held in position, but the pivot points move in their circular grooves to the position of FIG. 24A. The manipulator can then advance the target again. The grasping surfaces can incrementally advance a target or other object while retaining some grasping force to resist retreat of the target. The advancement resembles that when using a ratchet. The grasping surfaces roll only one way, but do not pull back the target.

In still other embodiments manipulators having grasping surfaces that perform other tasks to assist the manipulator are contemplated. For example, FIGS. 25A-25E illustrate a pair of further grasping surfaces 2504 a, 2504 b for use with embodiments of manipulators in accordance with the present invention and actuation of the pair of the grasping surfaces 2504 a, 2504 b. The pivot points 2506 a, 2506 b of the grasping surfaces 2504 a, 2504 b are arranged proximate to one another in the unactuated position, with the grasping edges 2520 a, 2520 b operating so that they rotate away from each other. This motion allows the manipulator to be used within a predefined operating space. Such manipulators can, for example, be advanced through a tube having a known or unknown diameter.

FIGS. 26A-26D illustrate a pair of further grasping surfaces 2604 a, 2604 b for use with embodiments of manipulators in accordance with the present invention arranged within a tube 12 with the back edges of the grasping surfaces 2604 a, 2604 b against each other. As the grasping surfaces 2604 a, 2604 b are rotated about a pivot point 2606 a, 2606 b at their respective distal ends, the grasping edges 2620 a, 2620 b push outward to expand the diameter of the tube 12. The expanded tube can increase access to a target site, improve flow through the tube, allow introduction of tools or other tubes, etc.

FIGS. 27A and 27B illustrate an embodiment of a manipulator 2700 in accordance with the present invention adapted for pulling in and grasping tissues with large surfaces and mass and adapted for manipulation in deep layers. The static process of grasping is divided into two stages, the first stage including static grapping and the second phase including dynamic pulling in and fixing of the tissue. The grasping surfaces 2704 a, 2704 b are not actuated by a spring bias, but rather are pivoted by separate mechanics independent, or semi-independent of arm movement. For example, the grasping surfaces 2704 a, 2704 b can be pivoted by cables, complementary arms, etc. In this embodiment, the grasping surfaces 2704 a, 2704 b start to rotate while the arms 2702 a, 2702 b are closed. The arms then begin to open. The manipulator can be useful, for example, in combination with endoscopes, enabling a large quantity of tissue on a large surface to be precisely grasped. The manipulator 2700 comprises a pair of arms 2702 a, 2702 b each of which is connected with a grasping surface 2704 a, 2704 b at a pivot point 2706 a, 2706 b. The grasping surfaces 2704 a, 2704 b have a semi-parabolic shape that curves outward with a convex orientation relative to respective arms 2702 a, 2702 b. The arms 2702 a, 2702 b of the manipulator 2700, as with all of the embodiments of manipulators described herein, can be part of a hand actuated mechanism, for example as a pair of forceps, or alternatively the arms 2702 a, 2702 b can extend from a robot that can be controlled by a physician or controlled by an automated system.

FIGS. 28A-28E illustrate an embodiment of grasping surfaces 2804 a, 2804 b for use as a locomotive device, for example to advance an instrument or a more complex device such as a robot. As shown, pivot points 2806 a, 2806 b of the grasping surfaces 2804 a, 2804 b are connected with a device (shown schematically as a dotted line). The grasping surfaces 2804 a, 2804 b grip and advance along walls 2, 4 with the pivot points 2806 a, 2806 b being drawn forward along the walls 2, 4 (upwards relative to the page). Likewise, the connected device is drawn forward. The grasping surfaces 2804 a, 2804 b can be useful in myriad different applications, such as introducing instruments, cameras, and tools to an inaccessible disaster site, or moving a cleaning robot into a drain.

FIGS. 29A-29C illustrate an embodiment of an endoscope 2900 useable, for example, in a bowel or a catheter 2 in an artery. As shown in FIGS. 29A and 29B, the endoscope 2900 is shown being advanced through the catheter 2 (upward along the page) through movement of grasping surfaces in the form of plates 2904 a, 2904 b. FIG. 29C illustrates the head 2902 of the endoscope 2900. The moving mechanism is a cable 2990 which splits near the end of the head 2902 of the endoscope 2900 to connect to two or more (two as shown) patterned or toothed plates 2904 a, 2904 b. The plates 2904 a, 2904 b turn back at pivot points 2906 a, 2906 b at the end of the head 2902 of the endoscope 2900 and grip the walls of the catheter 2. Advancing the cable 2990, the plates 2904 a, 2904 b moves backward, advancing the endoscope 2900. This advancement can be limited to a length of the plates 2904 a, 2904 b and/or cable 2990; however, the advancement can assist in moving the endoscope 2900 when the endoscope 2900 cannot be advanced by pushing the endoscope 2900 along the catheter 2.

FIG. 30 is a top view a still further embodiment of a head 3000 for use with manipulators in accordance with the present invention. The arms 3002 a, 3002 b resemble a clip, connecting at a proximal end. A patterned plate 3004 having a “V” shape that acts as grasping surfaces is connected with a distal end of the arms 3002 a, 3002 b. As the distal ends of the arms 3002 a, 3002 b are urged together, the grasping surfaces of the plate 3004 grab, pulls in, and fixes a target between the arms 3002 a, 3002 b.

In certain embodiments described herein, application fields for the invention include, but are not limited to, grasping of tissues in locations difficult to access and movement within and manipulation of tubes and other walled structures. However, upon reflecting on the teachings contained herein, one of ordinary skill in the art will appreciate the myriad different applications and variations of actuatable grasping surfaces, all of which are intended to fall within the scope of the invention.

The previous description of the preferred embodiments is provided to enable any person skilled in the art to make or use the embodiments of the present invention. While the invention has been particularly shown and described with reference to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the spirit and scope of the invention. 

1. A manipulator adapted to grasp and draw tissue comprising: a first arm having a distal end and a proximal end; a second arm having a distal end and a proximal end; wherein the distal ends of the first and second arm are separated by a distance; a first grasping surface connected to and extending from the distal end of the first arm at a first pivot point; wherein the first grasping surface is rigid and cylindrical in shape; a second grasping surface connected to and extending from the distal end of the second arm at a second pivot point; wherein the second grasping surface is rigid and cylindrical in shape; wherein the first grasping surface and the second grasping surface are biased toward each other; wherein when the first arm and second arm are actuated to reduce the distance, the manipulator is adapted such that tissue, configured to be arranged between the first grasping surface and the second grasping surface, resists actuation of the first arm and the second arm; and wherein the first arm and second arm are further actuatable so that the first grasping surface and the second grasping surface pivot at respective first and second pivot points such that the distance between the distal ends of the first and second arms is reduced; and the manipulator is adapted such that tissue is configured to be drawn toward the proximal end of the first and second arms.
 2. The manipulator of claim 1 wherein: the first pivot point for the first grasping surface is off-center and near a first edge of the cylindrical shape of the first grasping surface; and the second pivot point for the second grasping surface is off-center and near a second edge of the cylindrical shape of the second grasping surface.
 3. The manipulator of claim 1 wherein: said first grasping surface is off-set from said first arm; and said second grasping surface is off-set from said second arm.
 4. The manipulator of claim 1 wherein: said first grasping surface is biased toward the second grasping surface by a first spring force; and said second grasping surface is biased toward the first grasping surface by a second spring force.
 5. A manipulator adapted to grasp and draw tissue comprising: a first arm having a distal end and a proximal end; a second arm having a distal end and a proximal end; wherein the distal ends of the first and second arm are separated by a distance; a first grasping surface connected to and extending from the distal end of the first arm at a first pivot point; wherein the first grasping surface is curved in shape, and the first pivot point for the first grasping surface is off-center and near a first edge of the first grasping surface; wherein the first grasping surface is off-set from said first arm; wherein said first grasping surface is roughened; a second grasping surface connected to and extending from the distal end of the second arm at a second pivot point; wherein the second grasping surface is curved in shape, and the second pivot point for the second grasping surface is off-center and near a second edge of the second grasping surface; wherein the second grasping surface is off-set from the second arm; wherein the second grasping surface is roughened; wherein said first grasping surface is biased toward the second grasping surface by a first spring force; wherein said second grasping surface is biased toward the first grasping surface by a second spring force; wherein when the first arm and second arm are actuated to reduce the distance, the manipulator is adapted such that tissue, configured to be arranged between the first grasping surface and the second grasping surface, resists actuation of the first arm and the second arm; and wherein the first arm and second arm are further actuatable so that the first grasping surface and the second grasping surface pivot at first and second respective pivot points such that the distance between the distal ends of the first and second arms is reduced; and the manipulator is adapted such that tissue is configured to be drawn toward the proximal ends of the first and second arms.
 6. The manipulator of claim 5 wherein: a first torsion spring applies the first spring force to bias the first grasping surface away from the first arm; and a second torsion spring applies the second spring force to bias the second grasping surface away from the second arm.
 7. The manipulator of claim 1 wherein the first grasping surface and the second grasping surface are offset from a plane defined by the first arm and the second arm in order to avoid interference with said first and second arms.
 8. The manipulator of claim 5 wherein the first grasping surface and the second grasping surface are offset from a plane defined by the first arm and the second arm in order to avoid interference with said first and second arms.
 9. The manipulator of claim 5 wherein the first grasping surface is roughened and the second grasping surface is roughened.
 10. The manipulator of claim 5 wherein the first grasping surface is rigid and cylindrical in shape, and the second grasping surface is rigid and cylindrical in shape.
 11. The manipulator of claim 10 wherein the first edge of the first grasping surface is an edge of the cylindrical shape of the first grasping surface, and wherein the second edge of the second grasping surface is an edge of the cylindrical shape of the second grasping surface.
 12. The manipulator of claim 1 wherein the first grasping surface is provided on a first disk and the second grasping surface is provided on a second disk.
 13. The manipulator of claim 5 wherein the first gasping surface is provided on a first disk and the second grasping surface is provided on a second disk.
 14. The manipulator of claim 5 wherein the first grasping surface is textured and the second grasping surface is textured.
 15. The manipulator of claim 1 wherein the cylindrical shape of the first grasping surface is elliptical and wherein the cylindrical shape of the second grasping surface is elliptical.
 16. The manipulator of claim 15 wherein the cylindrical shape of the first grasping surface is elliptical and wherein the cylindrical shape of the second grasping surface is elliptical.
 17. A manipulator adapted to grasp and draw tissue comprising: a first arm having a distal end and a proximal end; a second arm having a distal end and a proximal end; wherein the distal ends of the first and second arms are separated by a distance; a first grasping surface which is rigid, cylindrical and textured; a second grasping surface which is rigid, cylindrical and textured; wherein the first grasping surface is pivotally connected to the first arm; wherein the second grasping surface is pivotally connected to the second arm; wherein the first and second grasping surfaces are biased toward each other; and wherein the first and second grasping surfaces are off-set from a plane defined by the first and second arms in order to avoid interference with the first and second arms when the first grasping surface and the second grasping surfaces engage tissue between the first and second grasping surfaces.
 18. The manipulator of claim 17 wherein the first gasping surface is provided on a first disk and the second grasping surface is provided on a second disk.
 19. The manipulator wherein the first and second cylindrical grasping surfaces are elliptical.
 20. The manipulator of claim 17 when the manipulator is actuated to reduce the distance between the first and second arms, tissue configured to be held between the first and second grasping surfaces is drawn toward the proximal ends of the first and second arm. 